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Cholangitis

Definition

Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps digest food.

Causes, incidence, and risk factors

Cholangitis is usually caused by a bacterial infection, which can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver.

Risk factors include a previous history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and, rarely, travel to countries where you might catch a worm or parasite infection.

Symptoms

The following symptoms may occur:

• Abdominal pain
  • In the right upper side or middle of the upper abdomen
  • May come and go
  • Pain is sharp, crampy, or dull
  • Pain may move to the back or below the right shoulder blade
• Chills
• Fever
• Clay-colored stools
• Dark urine
• Nausea and vomiting
• Yellowing of the skin (jaundice) -- may come and go

Signs and tests

Tests may include:

• Abdominal ultrasound
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

The following blood tests may be done:

• Bilirubin level
• Liver enzyme levels
• Liver function tests
• White blood count (WBC)

Treatment

Quick diagnosis and treatment are very important.

Antibiotics to cure infection are tried first for most patients. ERCP or other surgical procedure is done when the patient is stable.

Patients who are very ill or are quickly getting worse may need surgery right away.

Support Groups

Expectations (prognosis)

The outcome is usually good with treatment, but poor without it.

Complications

• Sepsis

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of cholangitis.

Prevention

Treatment of gallstones, tumors, and infestations of parasites may reduce the risk for some people. A metal or plastic stent within the bile system may be needed to prevent recurrence.

References

Attasaranya S, Fogel EL. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin North Am. 2008;92(4):925-960.

Afdhal NH. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 159.